Errors in administration of medication through a fluid transfer system, such as a patient infusion system or an automatic compounder, can result from many causes, including misconnections. Accordingly, to reduce the potential for such errors, professional guidelines and/or standard operating procedures require clinicians, such as nurses and pharmacists, to perform “line management,” also known as line tracing, numerous times throughout their working shifts. In the case of an automatic compounder, line management involves verifying each medication source container is routed through tubing to the correct input of the mixing manifold and pump. In the case of a patient infusion system, line management involves verifying that each medication source container, typically a bag, bottle, or syringe, is routed through tubing to the correct catheter, and that the tubing is associated with the correct pump channel (if an infusion pump is used). The activity further includes verifying that it is safe to join two or more tubing segments containing different medications and/or flowing at different rates. By way of example, a nurse or other clinician may perform line management for each patient when starting a shift, when receiving a patient from another facility, another area of the hospital, or a different clinician, and just prior to administration of an intravenous medication. Repeated performance of the detailed line management procedure imposes a time burden on the clinicians, and is prone to errors, particularly as the complexity of a patient's overall infusion tubing system increases. That is, multiple tubing sets, medications, junctions, access ports, pump channels, and catheters increase the amount of time required to perform line management and also introduce additional opportunities for error in line management.
To facilitate line management, clinicians often manually label infusion setups at various locations throughout the tubing system. Generally, the labeling is crude, using materials on hand such as medical tape wrapped around the tubing and labeled with identifying information such as the medication name. This labeling is repeated at several points throughout the system. For example, labels may be placed at the spike end of a tubing set, at the catheter connection, at each access port and junction, on the roller clamp and slide clamp, on the catheter, on the pump channel itself, and on the medication container. When applying such labels, a clinician manually slides his or her hand along the tube, progressing from a first tube end to a second tube end, and labeling desired points along the length of the tube.
Line management systems should be capable of identifying the correct line, catheter, and connector prior to connecting any new medicine container and line or prior to injecting a medication into an existing access port. Additionally, the system should allow a user to correctly identify a container and its corresponding line and pump interface before loading the tubing line into the pump. The system should also maintain clear physical and visual association among the container, line, pump, and catheter. Proposed systems for facilitating the line management process include color coding of the tubing sets used in the infusion system, use of the tubing as an optical waveguide similar to glass or plastic optical fibers, and use of electrically conducting wires embedded in the wall of the tubing. Each of these solutions provides some advantages, but a primary disadvantage to each proposal is that it would require development of a specialized tubing set.
Accordingly, there is a need for a system that facilitates accurate line management without the need for development of new tubing systems.